彩色多普勒超声联合超声造影评价TIPS术后支架通畅性研究

Evaluation of stent patency after TIPS by color Doppler ultrasound combined with contrast-enhanced ultrasound

目的:评价使用直径8 mm聚四氟乙烯覆膜支架的患者,联合应用常规彩色多普勒超声及超声造影,对经颈静脉肝内门体分流术(TIPS)后支架通畅情况的临床应用必要性。方法:回顾性分析2019年4月至2022年3月就诊的因肝硬化门静脉高压行TIPS支架手术的患者20例,分别于TIPS术前1周,术后第7天,术后3个月、6个月以及术后1年进行二维及彩色多普勒超声常规检查,观察门静脉、脾静脉及TIPS支架内彩色血流情况,记录各自内径、最高血流速度,对常规超声检查有疑问的患者,行门静脉超声造影检查以进一步明确诊断。结果:术后各时间节点与术前相比,门静脉、脾静脉内径有所减小,但差异无统计学意义(P>0.05)。术后各时间节点间相比,门静脉、脾静脉内径及TIPS支架内径、最高血流速度差异无统计学意义(P>0.05)。术后7天至6个月,支架中段内径呈上升趋势,门静脉端至中段内最高血流速度呈下降趋势,术后1年,支架内径呈下降趋势,流速增加;支架内血流速度在为期1年观察期,门静脉端至肝静脉端存在递增趋势,但差异无统计学意义(P>0.05)。术后各时间节点与术前相比,门静脉、脾静脉最高血流速度均明显增加,差异有统计学意义(P<0.05)。结论:在使用直径8 mm聚四氟乙烯覆膜支架的患者中,联合应用彩色多普勒超声与超声造影,能够更好地评价支架功能,提高诊断的准确性,超声技术对TIPS支架功能进行定期随访具有必要性。

Objective:To evaluate the clinical necessity of combining conventional color Doppler ultrasound and ultrasonography for stent patency after transjugular intrahepatic portosystemic shunt(TIPS)in patients with an 8 mm diameter polytetrafluoroethylene overmolded stent.Methods:Retrospective analysis of 20 patients with cirrhotic portal hypertension who underwent TIPS stent surgery from April 2019 to March 2022 in our hospital were retrospectively analyzed,and routine 2D and color Doppler ultrasound examinations were performed 1 week before TIPS,on postoperative day 7,3 months,6 months,and 1 year after TIPS to observe the colored blood flow in the portal vein,splenic vein,and TIPS stent,and to record the respective For patients with doubts about the conventional ultrasound examination,portal vein ultrasonography was performed to further clarify the diagnosis.Results:The internal diameter of portal vein and splenic vein decreased at each time point after operation,but the difference was not statistically significant(P>0.05).There was no statistical difference in the internal diameter of the portal vein and splenic vein and the internal diameter of the TIPS stent and the maximum blood flow velocity compared between the postoperative time points(P>0.05).From 7 days to 6 months postoperatively,there was an increasing trend in the stent medial internal diameter and a decreasing trend in the maximum flow velocity from the portal vein end to the medial end.1 year postoperatively,there was a decreasing trend in the stent internal diameter and an increasing flow velocity;there was an increasing trend in the intra-stent flow velocity from the portal vein end to the hepatic vein end during the 1-year observation period,but there was no statistical difference(P>0.05).The highest flow velocities in the portal and splenic veins were significantly increased at all postoperative time points compared to the preoperative period(P<0.01,P<0.02),which was statistically different.Conclusion:The combined application of color Doppler ultrasound and ultrasonography in patients with an 8 mm diameter polytetrafluoroethylene overmolded stent can better evaluate stent function and improve diagnostic accuracy,and ultrasound technology is necessary as a screening tool for regular follow-up of TIPS stent function.